APTA Issues Statement on 'Improvement Standard' Final Settlement

"APTA
is pleased with the decision of the federal court to approve the final
settlement in the class action 'Improvement Standard' lawsuit (Jimmo vs Kathleen Sebelius), which
upheld the right of patients to continue to receive reasonable and necessary
care to maintain their medical conditions and prevent or slow decline,"
says APTA
President Paul A. Rockar Jr, PT, DPT, MS, in a statement issued today. "We look
forward to working with the Centers for Medicare and Medicaid Services (CMS)
and its contractors to ensure the appropriate and equitable application of
patient care as outlined in the settlement. We believe this final settlement
reinforces the fundamental right established in the Medicare statute that
affords patients the right to receive the services necessary to treat their
diagnoses or illnesses."

The
final settlement directs CMS to revise its Medicare Benefits Policy Manual to
set a maintenance coverage standard and launch a national educational campaign
to explain the clarified benefit to its contractors, providers, and
beneficiaries. "APTA is eager to serve as an active partner as the agency
begins this work. Over the next several months, we will provide clinical and
professional expertise to CMS to define appropriate treatment in accordance
with our professional standards," Rockar says.

While
CMS works to publicize changes and new resources, APTA will actively educate
members on how to give appropriate care as defined by this final settlement.

Comments

This ruling is so important for those who have been declined services and continue to decline rapidly without treatment. The frontlines of medical care have been redefined by the court. Amen

Posted by Tom Brocato
on 2/9/2013 8:18 AM

This ruling is critically important for those with chronic disease. We can keep them on service and prevent complications and possibly unnecessary hospitalizations. Nothing could be better for our patients and the greater healthcare system.

Posted by Sue O'Brien
on 2/10/2013 7:31 PM

I think it is important and at the same time amazing for us to realize that the "improvement requirement" has been an illegal rule of thumb created by many intermediaries or contractors. We as providers (most especially the new grads) have been bullied into believing this requirement was part of the "Medicare" rules or the Code of Federal Regulations. "Medicare" or more importantly the Code of Federal Regulations has never actually had an "improvement requirement." The Code of Federal Regulations actually supports the establishment and monitoring of a program by PT's. Sometime in the mid 80's the home health section printed a two part article from Edward Dale and an organization known as Legal Assistance to Medicare Patients (LAMP). Mr Dale taught us how to be advocates for our patients. Would be nice to see a reprint of this article on the APTA website.
Thanks,
Joseph M. Eschman PT, DPT, GCS

Posted by Joseph Eschman
on 2/12/2013 9:33 AM

This is welcomed news! I hope there will be carry over to the private insurers who also deny visits as sooon as a patient's progress plateaus.